# LV-unloading tijdens ECMO bij cardiogene shock

*geplaatst 2019-02-19 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2018.10.085 · https://hartvaat.nl/2019/02/19/lv-unloading-tijdens-ecmo-bij-cardiogene-shock/*

Studie naar linkerkamer-ontlasting tijdens ECMO bij patiënten met cardiogene shock. Optimalisatie van mechanische circulatoire ondersteuning.

## English: Left Ventricular Unloading During Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock.

This study evaluated strategies for left ventricular unloading during VA-ECMO in cardiogenic shock, comparing the outcomes of different mechanical approaches to reduce the deleterious effects of LV distension during extracorporeal support.

## Abstract (original, from the publication)

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulatory support in patients with refractory cardiogenic shock. A common drawback of this modality is a resultant increase in left ventricular afterload. OBJECTIVES: The purpose of this meta-analysis was to examine the efficacy and safety of left ventricular unloading strategies during VA-ECMO in adult patients with cardiogenic shock. METHODS: The authors performed a systematic search of studies examining left ventricular unloading during VA-ECMO in Medline, EMBASE, and the Cochrane library. The primary outcome was all-cause mortality. Secondary outcomes included limb ischemia, bleeding, need for renal replacement therapy, multiorgan failure, stroke or transient ischemic attack, and hemolysis. RESULTS: Of 2,221 publications identified, 17 observational studies met the inclusion criteria. In total, outcomes in 3,997 patients were included with 1,696 (42%) receiving a concomitant left ventricular unloading strategy while on VA-ECMO (intra-aortic balloon pump 91.7%, percutaneous ventricular assist device 5.5%, pulmonary vein or transseptal left atrial cannulation 2.8%). There were 2,412 deaths (60%) in the total cohort. Mortality was lower in patients with (54%) versus without (65%) left ventricular unloading while on VA-ECMO (risk ratio: 0.79; 95% confidence interval: 0.72 to 0.87; p < 0.00001). Hemolysis was higher in patients who underwent VA-ECMO with left ventricular unloading. Otherwise, secondary outcomes were not demonstrably different in patients treated with VA-ECMO with versus without left ventricular unloading. CONCLUSIONS: In observational studies, left ventricular unloading was associated with decreased mortality in adult patients with cardiogenic shock treated with VA-ECMO. In the absence of prospective randomized data, left ventricular unloading may be considered for appropriately selected patients undergoing VA-ECMO support.

Auteurs: Juan J Russo, Natasha Aleksova, Ian Pitcher, Etienne Couture, Simon Parlow, Mohammad Faraz, Sarah Visintini, Trevor Simard, Pietro Di Santo, Rebecca Mathew, Derek Y So, Koji Takeda, A Reshad Garan, Dimitrios Karmpaliotis, Hiroo Takayama, Ajay J Kirtane, Benjamin Hibbert

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2018.10.085. Bijgewerkt 2026-07-03T13:27:00Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.